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Influence of inhaled corticosteroids on growth: a pediatric endocrinologist's perspective
1Pediatric Endocrinology and Pediatric Residency Training, University of Wisconsin School of Medicine, Madison 53792, USA.
Insights
Inhaled corticosteroids (IC) may slow growth in children with persistent asthma. Further research is needed to determine if this growth suppression affects final adult height, impacting long-term health outcomes.
Area of Science:
- Pediatric Endocrinology
- Respiratory Medicine
- Pharmacology
Background:
- Increasing use of inhaled corticosteroids (IC) for persistent asthma exposes more children to potential growth-suppressing effects of glucocorticoids.
- Current evidence indicates that moderate, consistent doses of IC can slow growth in children.
- The long-term impact of IC-induced growth suppression on final adult height is not yet understood.
Purpose of the Study:
- To review current knowledge on the mechanisms by which glucocorticoids suppress growth.
- To examine the effects of inhaled corticosteroids on pediatric growth.
- To propose recommendations for future study designs investigating drug effects on growth.
Main Methods:
- Literature review of existing studies on glucocorticoid mechanisms and inhaled corticosteroid effects on growth.
- Analysis of therapeutic strategies in persistent asthma management and their potential impact on growth.
- Formulation of recommendations for designing future clinical trials.
Main Results:
- Glucocorticoids, including IC, have demonstrated the capacity to slow growth in children when administered consistently at moderate doses.
- Therapeutic approaches prioritizing continuous inflammatory control over periodic symptom management may heighten the risk of growth failure.
- The long-term consequences of this growth suppression on adult height remain an area requiring further investigation.
Conclusions:
- Inhaled corticosteroids are associated with growth suppression in children, necessitating careful monitoring.
- The clinical significance of this effect on final adult height requires dedicated research.
- Standardized study designs are recommended to accurately assess the impact of medications on pediatric growth.
Abstract:
Given the increasing advocacy for the use of inhaled corticosteroids as a treatment of choice for persistent asthma, growing numbers of children are being exposed to the possible growth-suppressing effects of glucocorticoids. Recent evidence strongly suggests that, when consistently administered at moderate doses, inhaled corticosteroids (IC) are capable of slowing growth in children. Whether such growth suppression would persist and ultimately affect final adult height remains unknown. Therapeutic goals which aim for uninterrupted inflammatory disease control rather than periodic symptom control may increase the occurrence of growth failure in children treated with IC. In this article, current information about the mechanisms of growth suppression by glucocorticoids and the effects of IC on growth is reviewed, and recommendations for designing studies to investigate the effects of drugs on growth are presented.